TABLE 37.2 BLOOD PRESSURE LEVELS (STAGE AND STAGE HYPERTENSION) FOR CHILDREN OF AVERAGE HEIGHT a (50TH PERCENTILE) AT SELECTED AGES EVALUATION AND DECISION Children with a persistently elevated blood pressure level in the ED require a brief but thorough history and physical examination, with emphasis on detecting an underlying cause for hypertension and eliciting signs and symptoms of endorgan damage resulting from the hypertensive process In the absence of concerning findings in the history or physical examination, the child with elevated blood pressure or stage hypertension should be referred for follow-up with the primary care physician Although it is appropriate to initiate the process of patient education in the ED regarding weight loss, dietary salt reduction, and exercise, a definitive diagnosis of hypertension should not be offered until elevated blood pressure has been confirmed on several occasions